I've been reading The Sociopath Next Door by Martha Stout -- an excellent and yet frustrating book about antisocial personality disorder. Stout's engaging style and in-depth clinical experience with victims of sociopathic predators bring the subject to vivid life. The vignettes read more like suspense novels: as the character of the sociopath gradually unfolds, your sense of foreboding grows. You continue reading with a mixture of dread and fascination, wondering what will happen to Stout's clients, whether they will extricate themselves from the manipulative grip of an unfeeling spouse or parent, whether the unsuspecting people who surround the sociopath will wake up in time. I found the book a gripping read.

It's a practical book, too: Stout explains with great clarity how to recognize sociopaths, placing special emphasis on their efforts to arouse your pity in order to manipulate you. She has a set of thirteen rules for dealing with the sociopath, useful advice for the person who may be under the spell of someone with antisocial personality disorder. Although she doesn't normally recommend avoidance as a coping device for her clients, Stout believes that steering completely clear of the sociopath is the most effect mode of self-defense. Because sociopaths have no "conscience," as she describes it, there is no way to appeal to their sense of justice or fairness. Because they apparently lack all human feeling for other people (empathy), you can't appeal to their compassion. Because sociopaths will do anything in order to win, once you enter into their game, you're bound to lose. Her observations seem trenchant, her advice on point.

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Should Psychotherapy Be a Judgment-Free Zone?

Joseph Burgoin

Social Behavior

The Psychotherapy Relationship

August 16, 2013August 16, 2013

Many years ago, back when I still lived in Los Angeles, I worked for a brief time with a client who was secretly draining his wife's inheritance to support their family. He didn't make personal use of the money or spend it on a mistress; instead, he took his family on lavish vacations, pretending to have earned the money himself, and used it to fund a lifestyle they couldn't afford. This man worked in a field with the potential to earn large sums of money if he invested properly (and got lucky); he continually hoped to hit "the big one" and replenish the investment account where his wife had placed her inheritance. He hoped she would never learn what he had done. He eventually ran through the inheritance, however, and when his wife discovered the truth, she divorced him. Not long after, he discontinued treatment for financial reasons and, I believe, left the country.

Shortly after the truth came out, the wife called me. She had looked into the legal and ethical guidelines and acknowledged that I was "probably covered," as she put it, but she nonetheless felt my behavior was morally wrong -- that I had a moral obligation to tell her about what her husband was doing. It didn't help to explain that what she expected me to do would've violated my client's right to privacy and my legal obligation to preserve confidentiality. She regarded it as a moral issue. I didn't then and I don't now agree with her. And because I wasn't her therapist, I couldn't help her examine her own collusion in those unhappy events. My client had a history of lying and concealing the truth about money which she knew about, so it was surprising that she had made him a co-signator on the investment account and hadn't looked at a bank statement or checked the balance in years.

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Codependency Issues in Marriage

Joseph Burgoin

Relationship Issues

The Psychotherapy Relationship

August 3, 2013August 3, 2013

I received an email earlier this week from a married friend of mine who always signs off, "With love from Natalie and Jeff." Jeff has never sent me an email nor, as far as I can tell, does Natalie consult with him in advance about what she plans to write. Despite its inclusive closing, the email came from Natalie alone. I was reminded of a couple I knew back in Los Angeles, Tom and Molly, who shared a single email address: tomolly@whatever.com. It was a clever play on the word tamale, of course; but even then, in the early days of email, I wondered why they didn't have separate addresses. Marriage involves the formation of a new joint identity, but for some married people (and for some unmarried couples, too), this new combined identity overshadows and often eclipses a separate sense of self for its members.

"I now pronounce you husbandwife."

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Some Thoughts About Mania

Joseph Burgoin

Depression and Bipolar Disorder

July 21, 2013July 21, 2013

During my recovery from overload (the result of having ignored my personal limitations), I've found my thoughts turning to the psychodynamics of mania. Over the last few years as my clinical and theoretical focus has shifted to the role of shame in bipolar disorder, I've paid less atttention to rage and the sense of entitlement -- the way they can often fuel a manic episode. It's true that I've written about these experiences in connection with borderline personality disorder but have neglected their role in manic-depressive illness.

Grandiose or magical thinking reflects the wish to achieve something all at once -- to become wealthy or famous, or to complete a creative project without having to undertake the long hard work necessary for authentic achievement. In some cases, the underlying depression is so profound and the psychological damage from a traumatic childhood so pervasive that realistic growth is felt to be impossible -- thus the magical all-at-once solution seems the only way out. Think of this as true mania, intimately connected with shame. Other people not so damaged by life, not so riddled with shame may also long to achieve things faster than may be possible in reality; they may resent the self-discipline, patience and deprivation necessary to achieve major goals. Rather than delusional, truly manic states of mind, they may try to achieve their goals through sustained bursts of activity that may last for weeks or even months. Such hypomanic states of mind may actually lead to actual achievement, but they reflect an underlying impatience and, in many cases, an angry denial of the need for a more consistent, slow-and-steady approach to accomplishment.

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Respecting Your Personal Limitations

First of all, I'd like to thank those of you who visit the site often enough to have noted my absence this past month and written to me with concern. It has been a trying time, in part because of unexpected challenges that have come along but also because I haven't taken care of myself as well as I should.

In Don Nathanson's excellent book Shame and Pride, he describes himself as "the driven sort of personality that must ignore or disavow exhaustion in order to conclude what we declare to be the 'more important' business of the day." I recognize myself in this description. As I was working on Cinderella, I felt driven to complete and release it before relocating to Colorado for the summer, imposing an entirely artificial deadline upon myself. At the same time, I was finishing up a proposal for my book on shame, in the hope that I could interest a good agent in taking me on. I also wanted to finish that project before Colorado, although there was no particular reason why I needed to wrap it up in May rather than July. Like Nathanson, I continually made "the decision to trade the comfort of sleep for the work of writing." By the end of May, I had completed and released Cinderella, finalized my book proposal and driven myself into a state of exhaustion.

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personal limitations